UTIs (Dr. Withey)

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  1. What are the 5 locations where UTIs are most common?
    • 1. Kidney (Pyelonephritis)
    • 2. Ureter (Ureteritis)
    • 3. Bladder (Cystitis)
    • 4. Prostate (Prostatitis)
    • 5. Urethra (Urethritis)
  2. Which UTIs are located in the lower UT?
    • Cystitis
    • Prostatitis
    • Urethritis
  3. Which UTIs are located in the upper UT?
    • Pyelonephritis
    • Intra-renal abscess
    • Perinephric abscess
  4. What pathogen(s) are the most likely causative agent(s) for uncomplicated UTIs?
    • E. coli
    • S. saprophyticus
  5. What pathogen(s) are the most likely causative agent(s) for complicated UTIs?
    • E. coli
    • S. saprophyticus
    • Klebsiella spp.
    • and many others!
  6. What is the clinical presentation for lower UTIs (cystitis)?
    • Dysuria
    • Urinary urgency and frequency
    • bladder fullness
    • hemorrhagic cystitis (10% of cases)
  7. What is the clinical presentation for lower UTIs (prostatitis)?
    • pain and tenderness in lower back and suprapubic area
    • perirectal area and testicles
    • acute onset
    • more severe symptoms
    • bacteremia and hematuria
  8. What is the clinical presentation for upper UTIs (pyelonephritis)?
    • cystitis symptoms (Dysuria, Urinary urgency and frequency, bladder fullness, hemorrhagic cystitis (10% of cases))
    • fever, sweating
    • N/V/D
    • flank pain
    • dehydration, hypotension
    • septicemic shock
  9. What are th pathogenic  mechanisms for UTIs?
    • entry by ascent from urethra
    • often caused by poor hygiene
    • adherence to host epithelium - adhesins, pili, and polysaccharides
  10. What E. coli virulence factors contribute to UTIs?
    • P-pili associated with pyelonephritis (PAP) - mediate binding to uroepithelial cells via glycosphingolipids, and also binds to RBC leading to hemagglutination; inhibits phagocytosis, mannose insensitive, induces interleukin and PMN infiltration to bladder
    • Type 1 pili - agglutinates RBC and mediates binding, mannose sensitive, genetic switch
    • Type S fimbriae (SfaI, SfaII) - agglutinates RBCs, mannose insensitive, causes both cystitis AND pyelonephritis, binds sialic acids on glycoproteins, assoc. with neonatal meningitis and bacteremia
    • afimbrial adhesins (AfaD, AfaE) - adhesion to uroepithelium and internalization
    • toxins - hemolysin, needs iron for growth; cytotoxin necrotizing factor type I - apoptosis of uroepithelium
    • LPS - endotoxin, stimulates proinflammatory cytokine release
    • K antigen - capsule, antiphagocytic
  11. What S. saprophyticus virulence factors contribute to UTIs?
    • S. saprophyticus surface-associated protein
    • hemagglutinin/fibronectin-binding protein
    • hemolysin - not found in all uropathogenic strains
    • urease - toxic to bladder tissue, can form stones which can obstruct UT and impede urinary flow
  12. What K. pneumoniae virulence factors contribute to UTIs?
    • Type 1 fimbriae - mannose sensitive hemagglutinin
    • Type 3 fimbriae - mannose resistant hemagglutinin
    • Capsule - bilayer, antiphagocytic
    • LPS - serum-resistance, O antigen
    • Urease - stone formation
  13. What P. mirabilis virulence factors contribute to UTIs?
    • Adhesins - Mannose-resistant Proteus-like (MR/P), hemagglutinin
    • Proteus mirabilis fimbriae (PMF) - not a hemmaglutinin
    • flagella - motility
    • urease - foul smelling, ammonia; stone formation
    • HpmA hemolysin - potent, cytotoxic
  14. What Enterococcus spp. virulence factors contribute to UTIs?
    • Aggregation substance (Asa1) - conjugal plasmid exchange between cells, adhesion to eukaryotic cells expressing integrins
    • cytolysin - kills RBCs, release iron for growth
    • sex pheromones - plasmid acquisition, triggers immune response
  15. What are the host factors involved in UTIs?
    • mannose receptors on uroepithelial cells
    • women with recurrent UTI have more mannose receptors
    • certain blood groups are more prone to have recurrent UTIs
  16. What are the 5 host protective mechanisms to help fight UTIs?
    • normal flora
    • flushing
    • sloughing of uroepithelium
    • high osmolality, low pH of urine
    • insignificant immune defense
Card Set:
UTIs (Dr. Withey)
2012-09-06 03:37:15

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